Dosage & Administration Drug label Prior authorization Financial assistance PubMed™ News

Pluvicto

(vipivotide tetraxetan)

12.5 ML lutetium Lu 177 vipivotide tetraxetan 27 MCI/ML Injection [Pluvicto]

NO BOXED WARNING

Dosage & administration

* Select patients for treatment using LOCAMETZ® or an approved PSMA-11 imaging agent based on PSMA expression in tumors.
* Recommended Dosage: Administer 7.4 GBq (200 mCi) every 6 weeks for up to 6 doses.
* Dose interruption, reduction, or permanent discontinuation may be required due to adverse reactions.

drug label

Pluvicto prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Pluvicto prior authorization resources

Most recent Pluvicto prior authorization forms

View By Payer

Verified: Apr 07, 2024Kaiser Foundation Health Plan - Chronic High-Dose Opioid Therapy Prior Authorization Form Washington

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Medicare Prescription Drug Medication Request Form

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Short Acting Opioid Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Specialty Drug Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Non-Formulary Drug Coverage Prior Authorization Form

Most recent state uniform prior authorization forms

Verified: Mar 28, 2024Arizona - Uniform Prior Authorization Form

Verified: Mar 28, 2024Colorado - Uniform Prior Authorization Form

Verified: Mar 28, 2024Hawaii - Uniform Prior Authorization Form

Verified: Mar 28, 2024Illinois - Uniform Prior Authorization Form

Verified: Mar 28, 2024Indiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Louisiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Minnesota - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Mexico - Uniform Prior Authorization Form

Verified: Mar 28, 2024Oregon - Uniform Prior Authorization Form

Verified: Mar 28, 2024Texas - Uniform Prior Authorization Form

Coverage Authorization Appeals

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Benefits investigation

AAA PatientCONNECT Pluvicto Enrollment Form

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financial assistance

Pluvicto financial assistance options

Co-pay savings program

commercial only

AAA PatientCONNECT Pluvicto Enrollment Form

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Foundation programs

under insured

no insurance

goverment insurance

65+

AAA PatientCONNECT Pluvicto Enrollment Form

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

PubMed™ | Pluvicto

Pluvicto PubMed™ News

patient education

Pluvicto patient education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link